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Implementing HIV Prevention in Sub-Saharan Africa: A Systematic Review of Interventions Targeting Systems, Communities, and Individuals

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Abstract

HIV remains a threat to global public health, disproportionately affecting countries across Sub-Saharan Africa. Although treatment and access to care have improved, prevention remains critical to ending new HIV infections by 2030. A variety of prevention strategies exist, yet their effectiveness is difficult to measure and variable due to the nature of the interventions and vulnerability of the intervention during implementation. This systematic review of 51 studies synthesizes data on the implementation and evaluation of evidence-based HIV prevention interventions across Sub-Saharan Africa. Studies were included if they occurred between January 1, 2008, and December 31, 2019, inclusive in Sub-Saharan Africa, were written in English, implemented an HIV prevention intervention in the field, and had reportable results. Using a modified social-ecological model for HIV prevention, we divided studies into three categories: interventions targeting health systems (n = 16), communities (n = 8), and individuals (n = 27). Across all categories, the data emphasized preventing mother-to-child transmission (PMTCT), medical interventions, and psychosocial interventions. The most successful programs bundled several interventions that were integrated into the health system. There is a notable lack of interventions targeting key populations and there are significant rates of loss to follow up (LTFU) across many studies. This review provides insight into the prioritization of evidence-based HIV prevention interventions across Sub-Saharan Africa.

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Data Availability

Data are fully available without restriction. No primary data were collected as part of this manuscript. The reviewed data are available in all references cited.

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Funding

The authors are grateful for the support of the National Institute of Mental Health (Award Number R01 MH110358) and the National Institute of Nursing Research of the National Institutes of Health (NIH) (Award Number R01 NR016650).

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Authors and Affiliations

  1. School of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Sarah F. Rapaport & Austin D. Peer

  2. Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    Nikita Viswasam, Elizabeth Hahn, Sofia Ryan, Gnilane Turpin, Carrie E. Lyons & Stefan Baral

  3. Department of Emergency Medicine, Johns Hopkins University School of Medicine, Suite 200, 5801 Smith Avenue, 21209. 410-735-6450, Baltimore, MD, USA

    Bhakti Hansoti

  4. Department of International Health, Bloomberg School of Public Health, Baltimore, MD, USA

    Bhakti Hansoti

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  1. Sarah F. Rapaport
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Contributions

BH, SB and GT conceived the study; CL, GT, BH, EH, and SR developed the initial search strategy and completed the initial search, SFR, ADP, NV, and BH completed data abstraction for the selected articles and updated the search; SFR, ADP, and BH contributed to the synthesis of the results and the writing of the manuscript; all authors reviewed, edited and approved of the final version of the manuscript.

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Correspondence to Bhakti Hansoti.

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This study is a systematic review of the peer-reviewed published literature so informed consent was not needed as no patient level were included in this study.

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Appendix

Appendix

Appendix 1: Overview of search strategies. (Supplementary material 2).

Appendix 2: Appendix of all HIV prevention articles included in this review. (Supplementary material 3).

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Rapaport, S.F., Peer, A.D., Viswasam, N. et al. Implementing HIV Prevention in Sub-Saharan Africa: A Systematic Review of Interventions Targeting Systems, Communities, and Individuals. AIDS Behav 27, 150–160 (2023). https://doi.org/10.1007/s10461-022-03751-0

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